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Dissertation
Gender-responsive monitoring and evaluation in school-based vision programs: advancing eye health and equity outcomes in Philadelphia
Doctor of Public Health (Dr.P.H.), Drexel University
Jun 2026
DOI:
https://doi.org/10.17918/00011410
Abstract
Vision impairment is a significant yet often overlooked barrier to academic success among school-aged children, and school-based vision programs (SBVPs) represent a critical public health strategy for early identification and treatment. Despite widespread implementation across the United States, a fundamental tension persists that while SBVPs are designed to promote equitable access to care, the monitoring systems used to evaluate them are rarely structured to detect whether equity is being achieved. This dissertation examines that gap, focusing on how sex, gender, and socioeconomic context shape vision screening outcomes and what existing data systems can and cannot reveal about equity within SBVPs. Using a convergent parallel mixed methods design, this study investigates SBVP implementation across three vision partners in the School District of Philadelphia (SDP): Wills Eye Hospital, Pennsylvania College of Optometry, and Vision To Learn, serving children in grades PK-8 during the 2024-2025 academic year. Aim 1 presents a systematic literature review of U.S.-based SBVP studies published between 2014 and 2024, demonstrating that while sex is frequently reported, it is rarely analyzed as an equity-relevant variable. Aim 2 examines sex-disaggregated vision screening outcomes across socioeconomic school contexts using routine program data, finding that observed patterns largely reflect differences in program workflows, scale, and documentation structures rather than independent equity effects. Aim 3 explores how SBVPs are implemented and monitored in practice through qualitative interviews with school nurses and optometrists, identifying how implementation conditions, monitoring practices, and barriers to follow-up care shape what is captured within routine data and how sex and gender considerations emerge within these processes. Collectively, findings demonstrate that equity cannot be inferred from routine operational indicators alone. While emerging population-level data systems can identify where disparities exist, they do not capture how children move through the screening-to-care pathway or where inequities arise within program implementation. This dissertation shows that meaningful Gender-Responsive Monitoring and Evaluation requires intentional indicator design, implementation-sensitive evaluation, and contextual interpretation of program data. This study represents the first systematic, sex-disaggregated analysis of SBVP outcomes across three Philadelphia vision partners and offers a replicable mixed methods approach for strengthening equity-responsive monitoring in SBVPs. Findings have direct implications for vision partners, the SDP, the Philadelphia Department of Public Health, and broader national efforts to build data systems capable of identifying and addressing inequities in pediatric eye care.
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Details
- Title
- Gender-responsive monitoring and evaluation in school-based vision programs
- Creators
- Pooja Sanat Doshi
- Contributors
- Randall Sell (Advisor)
- Awarding Institution
- Drexel University
- Degree Awarded
- Doctor of Public Health (Dr.P.H.)
- Publisher
- Drexel University
- Number of pages
- xi, 252 pages
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Dana and David Dornsife School of Public Health; Drexel University
- Other Identifier
- 991022189597204721